Penis Enlargement

Penis Enlargement/Phalloplasty is a procedure done to thicken the penis with fat transfer by 20-30%. Phalloplasty is augmentation or enlargement of the penis to increase its length, girth, or both.

 

Several surgical and medical conditions can lead to penile shortening. Conditions causing penile shortening are:

1. Prostate cancer is treated with radical prostatectomy (a surgical procedure for removal of the prostate)
2. Peyronie's disease (a condition where scar tissue causes the penis to curve or lose length or girth) and congenital anomalies (often-inherited medical conditions that occur at or before birth)
3. Moreover, studies suggest that erectile dysfunction may also play a role in penile shortening.
4. It is also reported that there is a significant decrease in penile length in men treated with hormonal suppression plus external radiation.

Penile enlargement surgery is done for cosmetic purposes. Most men opt for this surgery for the following reasons:

1. A feeling of discomfort in homosocial situations, discomfort towards women because of the size of your penis
2. True hypoplasia (micropenis, which refers to an abnormally small but normally structured penis) 
3. Significant anxiety, distorted body image (an unrealistic view of how someone sees their body)
4. The desire for better proportions or correlation between dimensions at rest and during erection and between length and girth
5. The desire to improve the length, girth of the penis
6. The desire to impress women, the well-founded perception that genital size is incoherent with their body.

There is a significant psychological impact of micropenis in men. The following conditions can occur if the situation is left untreated:

1. Anxiety disorders similar to social phobia (Social Anxiety Disorder) 
2. These men may start engaging in avoidance behaviour and show profound and underlying fears about their appearance, ability to perform sexually, and social adequacy. A very distorted view of women and sexuality further perpetuates this fear.
3. These men may start feeling hopeless, depressed, and, in some cases, suicidal due to their anxiety and shame and lack of actual relationship experiences.

The treatment approach and selection of procedures is dependent upon your health condition and the opinion of your treating surgeon.

Fat transfer penis enlargement surgery involves the following steps:

1. In this procedure, fat will be removed from the abdomen or thighs by liposuction (a cosmetic procedure).
2. Fat will then be filtered to isolate fat cells, and other materials will be discarded. To ensure fat survival, the fat will be injected around the penile shaft using bespoke injection techniques. Since fat transfer cells come from your own body, there is no risk of an allergic reaction.
3. The fat transferred to the penis must be pure, and the fat cells remain intact. To this end, the surgeon uses LipiVage or Puregraft fat processing technology.
4. LipiVage creates a closed circuit between the fat donor site (usually the stomach, flanks, and lower back) and the fat recipient site (the penis). Just like LipiVage, Puregraft also forms a closed system for the transfer of pure fat.
5. A closed-circuit system improves fat survival and reduces infection risk by limiting exposure to air during removal and transfer.
6. The surgeon may stitch strips of fat beneath the skin of the penis (dermal fat grafting) or insert fat into the penis (fat transfer or fat transplant).

Consider these factors before undergoing cosmetic genital surgery:

1. The surgery will likely leave scars behind. Even though scars fade with time, they will always be visible.
2. Surgery can only lengthen or widen the shaft of the penis, not the head.
3. The surgery will only make the penis appear longer when flaccid – it will not be long when erect.

Preparations for the surgery include the following:

1. Physical health– a physical examination will help your surgeon decide whether treatment is necessary.
2. Medical history – some pre-existing conditions and operations you have had in the past may affect decisions about this surgery, including the kind of anaesthetic that is used.
3. Psychiatric history– Before considering cosmetic genital surgery, your surgeon may recommend or insist you receive counselling.
4. Risks and possible complications – it is vital that you understand the risks and complications to determine whether cosmetic genital surgery is best for you.
5. General or local anaesthesia may be used in this type of surgery.
6. The operation usually lasts up to 80 minutes.
7. You will be discharged on the same day of the surgery.
8. The surgeon may suggest that you take a specific medication or adjust the dose of a medicine you already take. Be sure to follow all instructions carefully.
9. Before the surgery, you will need to complete hair removal. You should begin hair removal only after consulting with the surgical team. A donor site should be chosen first.
10. At your initial appointment, the hospital will provide you with a hair removal template that you can provide to your hair removal specialist to help them with your hair removal plan

Please prepare by doing the following before your procedure:

1. The day before surgery, avoid eating or drinking anything after midnight. Gum, mints, and tobacco are not allowed. No water should be swallowed while brushing your teeth.
2. You should arrange to have someone (family/friend) drive you home after surgery.
3. Do not bring any valuables with you.
4. Make sure you check-in to the hospital for surgery when you arrive.
5. At check-in, you'll need your identification and insurance cards, as well as any co-pays or deductible payments.

You can expect the following:

1. You will be placed in a supine (lying on your back) position on the operating table.
2. Surgical draping (creating and maintaining a sterile field in a surgical area by covering the patient with an uncontaminated cloth called drape) will be applied except on the surgical area.
3. The surgical site will be cleaned with alcohol-based antiseptic solutions containing chlorhexidine gluconate (CHG).
4. During the surgery, the surgeon will remove fatty tissue harvested (removed) from another part of your body, and they will sew these strips of fat beneath the skin of the penis (dermal fat grafting) or insert fat into the penis (fat transfer or fat transplant). At the end of the implantation, the surgical wound will be closed and sutured (stitched) using a resorbable thread

Recovery process in Hospital:

1. Dressing change will be performed by the healthcare staff as needed.
2. Apply a cold pack frequently as needed.
3. On the evening of the surgery, you will be discharged with instructions for medical therapy at home and informed adequately about the recovery process.
4. You should limit your movement during the days of recovery.

24 hours after the surgery:

1. You should take your regular medication.
2. You may resume blood thinners if your surgeon has approved them.
3. Continue pain medication as needed. As an alternative to prescribed medications, Tylenol (relieves pain and reduces fever) extra-strength can be taken.[5,8]

Recovery process/expectation after hospital discharge:

Diet: 48 hours after the surgery, you can continue your normal diet and good fluid intake.

Wound care (dressing):

1. Stitches on the skin will dissolve automatically.
2. You may observe redness or slight separation of the wound. This is common and not a problem.
3. Replace the dressing once a day for 10 days. Put the yellow gauze on until you take your first shower (five days after surgery). 
4. After the operation, you should clean yourself with a washcloth and keep the wound dry for five days. The wound can be covered with a condom or a small plastic bag if you want to shower.
5. Use an antibiotic ointment (bacitracin, Neosporin, or polysporine) to the incision wound twice a day for five more days after removing the yellow gauze. Do not drive if you have discomfort or are taking narcotic pain medications (Vicodin, Percocet, Tylox, and the like).

Work, Activity, Restrictions:

You should avoid intense physical activity for 30 days and sexual and masturbatory activity for 60 days.

You should not use a bath/hot tub/swim for six weeks. Taking a shower is okay.

You should limit your work until you recover from the surgery.

Medicine:

You may be given narcotic medicines after the surgery. Narcotic pain medications can cause constipation, itching, nausea/vomiting, and dizziness. It is essential that you have regular bowel movements (may use Metamucil or milk of magnesium, which is used to treat constipation) and do not drive if taking narcotic medicines.

First Follow up Appointment

You must remember the following:

1. The day after surgery, you should visit your doctor for a follow-up.
2. At this appointment, the doctor will perform a wound check and your first dressing change.

Some of the possible complications of penile grafting surgery include:

1. Surgical risks such as bleeding or infection
2. Scarring that may be severe, raised, and itchy
3. Abnormal shape of the penis after fat transfer
4. Impotence (failure to get or maintain an erection
5. Tissue death along the wound or loss of skin
6. Additional surgery to treat complications

Risks- warning signs / possible signs of infection for which you should consult a doctor:

1. The medication you are taking does not control your pain well.
2. It takes you longer than eight hours to urinate.